Women who have high-risk pregnancies or complications in childbirth are up to eight times more likely to have heart disease later in life, statistics suggest. But many mothers — and their doctors — are unaware of the danger.
Emerging research shows heart disease is a long-term threat for women who develop diabetes or high blood pressure during pregnancy, for example. Also at higher risk: mothers whose babies were born too small or too soon.
Yet doctors typically do not advise these mothers about their risk or counsel them to watch for heart disease symptoms, says Dr. Noel Bairey Merz, cardiologist and director of the Barbra Streisand Women's Heart Center at the Cedars-Sinai Heart Institute in Los Angeles.
Bairey Merz says doctors can see heart attacks and strokes coming, often 10 or 20 years ahead of time — if they are on the lookout.
"This isn't rocket science," she says. "We just have to figure out how we can find the women who are at risk."
One such woman, Lara Hogan, gave birth to her son Zion at Cedars-Sinai in May of last year.
Sitting in her living room in Topanga Canyon, Calif., Hogan, who is now 41, recounts how she monitored her blood pressure throughout the pregnancy because she had been treated for hypertension in the past. Then, during her 36th week, her blood pressure spiked — a sign of the emergency condition known as preeclampsia.
Hogan and her husband, Chad, headed to Cedars-Sinai, where doctors told her they needed to deliver the baby that night.
But her blood pressure didn't come down after she gave birth — it kept rising.
"They had someone standing at my bedside monitoring me, in case anything happened," Hogan recalls. "I guess they were so nervous that I was going to have a stroke."
She didn't. But her baby stayed in the neonatal intensive care unit for eight days, and Hogan went in and out of the hospital as doctors tried to lower her blood pressure.
"It was a nightmare," she says. "All I'd dreamt about was this moment for so many years. It was like the opposite of everything I thought it would be."
Finally, the doctors were able to use medicine to bringing her blood pressure down. They referred Hogan to a postpartum heart health program led by Margo Minissian, a nurse scientist at Cedars-Sinai. Over the next several weeks, Minissian and Hogan's doctors helped her get to a proper dosage and routine that enabled her to stay out of the hospital.
Since then, Hogan has checked her pressure most days and plans to continue seeing doctors to manage her long-term cardiac risk. Zion, who recently celebrated his first birthday, just started walking and likes to play with his toy xylophone and drums.
Hogan hopes to have another baby soon, so has been checking in with Minissian again, to make sure her blood pressure is well-controlled before she gets pregnant. And now she knows she is at risk for heart disease later in life because of the complications surrounding Zion's birth.
"As much as I don't want to be thinking about my future heart health, or worrying about what's going to happen when I am older," Hogan says, "this is priority No. 1 for my health right now — for the sake of my son and my future children."
Heightened awareness of the link between pregnancy complications and heart disease is prompting greater outreach to the public, and to collaborative research between cardiologists and obstetricians. That could help "make tremendous strides toward reducing and preventing heart disease in women," says Bairey Merz.
About 80 percent of U.S. women give birth to at least one baby, and one-fourth of those have complications during the pregnancy or labor. Researchers are still trying to figure out why these complications would be linked to later heart problems. Pregnancy might contribute to vascular complications, they suggest as one hypotheses — or it might simply reveal existing problems.
"Pregnancy can really mimic the stressors of age," Minissian notes. Pregnancy, she says, could be "a woman's first physiological stress test."
To further explore the heart disease connection, Cedars-Sinai recently started following a small group of women who had pregnancy or labor complications. In a separate study, Bairey Merz and other researchers, funded by the National Institutes of Health, are tracking the health of 5,000 new moms at eight sites across the nation, to fill gaps in knowledge and develop recommendations for physicians.
The Women's Heart Alliance, an advocacy group, started by Cedars-Sinai and New York-Presbyterian Hospital/Weill Cornell Medical Center, is also working with obstetricians and other providers to raise awareness of this particular heart risk among women and their doctors.
"We've got a big advocacy and education piece that we should be doing together," says Dr. Barbara Levy, vice president of health policy for the American Congress of Obstetricians and Gynecologists. Cardiologists and women's health care providers are in a unique position to drive the research agenda, Levy says.
For now, women who have had complications in pregnancy or labor should alert their primary care doctors and have annual screenings for high blood pressure, Minissian says.
The American Heart Association and American Stroke Association also recommend that women who have had preeclampsia be evaluated for heart disease risk within a year of giving birth. Some may need medication or a referral to a cardiologist.
But most new mothers with less serious complications during pregnancy needn't rush to see a cardiologist, Levy says — they just need to eat healthfully, be active and get enough sleep. Immediately referring all these women to specialists could result in undue anxiety and unnecessary medical tests, she says. Not good for a busy new mom.
"It will cost a lot of money and a lot of her time while she is dealing with a baby," says Levy.
As part of the Cedars-Sinai project, Minissian screens certain women for cardiovascular risk within six months of delivery and follows up with them every year. She also tries to help them lead healthy lives to "avoid the whole heart disease trajectory altogether."
"These women are going to have their eyes wide open," Minissian says. "They are going to be looking for it, and they won't allow people to pat them on the back and say, 'Oh don't worry about that high blood pressure.' "
This story is part of NPR's partnership with Kaiser Health News. KHN is an editorially independent news agency funded by the Henry J. Kaiser Family Foundation. Follow Senior Correspondent Anna Gorman on Twitter @annagorman.
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